2015: AGES 5-14
PLEASE SELECT SESSION(S):
______JUNE 8-11, 2015 Time 9:00am-11:30pm
______JUNE 15-18, 2015 Time 9:00am-11:30pm
HELD AT:Thoreau Demonstration Academy 7370 East 71st Street, Tulsa, OK
REGISTRATION FEE:$75.00 (DUE BYMAY 15, 2015)
PAYMENT SELECTION:____CASH ____ONLINE
FILL OUT FORM BELOW AND BRING TO COACH WILL AT THOREAU
(MAKE PAYMENTS ONLINE THROUGH PAYPAL. WEBSITE LISTED BELOW)
OR
REGISTER ONLINE AT
www.tulsayouthsoccercamp.com
www.facebook.com/tulsayouthsoccercamp
CALL COACH WILL @ (918) 402-5927
------------------------------------ALL PAYMENTS ARE NON REFUNDABLE-----------------------------
Player’s Name:________________________________Date of Birth____________________
School Name___________________________Grade_______Age_____T-Shirt Size________
Parent(s)Name:_________________________________Parent(s)Cell__________________
Parent(s)Email______________________________________________________________
Parent/ Release Waiver:
I hereby release and hold harmless Tulsa County, Thoreau Demonstration Academy, Tulsa Public Schools and Tulsa Youth Soccer Camp, all coaches and staff, from any and all claims and liability of any kind of personal injury and property damage occurring during Camp participation. I certify that my child has primary medical coverage and is physically capable to participate in all Camp activities. I also authorize any necessary medical, diagnostic hospital procedure as may be performed by a licensed physician, nurse, paramedic, physician’s assistant, emergency technician or health care professional.
Parent Name (Please print) _________________________ Medical Notes: __________
Parent Signature _______________________Date________ _______________________ Emergency Phone Number:___________________________ _______________________
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